Challenges and policy concerns for health systems in small European states

Abstract

Background: A renewed interest in small states in Europe has occurred in the aftermath of the financial and economic crisis. Mainstream theories on vulnerability and resilience of small states are being re-examined. Health systems have been affected as a result of the crisis. There is a gap in the literature bridging small states and health systems. The aim of this study was to conduct a systematic literature review on health systems in small states. This knowledge is important to understand the implications of European policy on small health systems and therefore this review specifically addressed common policy concerns for health systems in small European states. Methods: A systematic literature review was carried out during April 2014 in PUBMED using the following MeSH terms: health system, health facilities, health manpower, policy, health planning, delivery of health care, health care reform in combination with any of the following Cyprus, Estonia, Latvia, Lithuania, Luxembourg, Malta, Slovenia or Iceland (population under three million). Screening of the articles was conducted and validated. Abstracts which met inclusion criteria were categorised according to keywords. The final articles selected for review underwent detailed content analysis by two independent reviewers. Themes were coded and the literature was mapped. Grey literature was also searched using national non-impact journals and health system reports as sources. Results: Preliminary results showed particular patterns for health system issues for different countries linked to their socioeconomic and geographic conditions. Primary care, attitudes of health professionals, manpower planning and organisation of highly specialised care emerge as important policy concerns. Conclusions: There is value in framing the findings from this study in the broader literature on small states and the vulnerability resilience axis. Small states increasingly look towards the European Union for shelter and support. A deeper understanding of the issues and policy concerns in small state health systems is necessary to ensure that European health policy is shaped to meet their needs. This is an area where appropriately crafted European policy can easily demonstrate added value.